Elevated serum tryptase in exercise-induced anaphylaxis,☆☆,

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CASE REPORT

K.Z., an 18-year-old male high school football player was seen in consultation; he was complaining of acute skin rashes and hives associated with exercise. He also stated that he could at times experience wheezing and dyspnea when the hives developed. However, not every outbreak of hives was associated with dyspnea, and at times, he noted that dyspnea could develop without hives. The hives could last up to 60 minutes after cessation of exercise, and dyspnea could last 30 to 45 minutes. This

DISCUSSION

This case report clearly and dramatically demonstrates the role of mast cells in EIA. The elevated plasma histamine levels mirror those previously reported, and the elevated serum tryptase levels further document mast cell involvement in an attack triggered by mild exercise at a medical care facility. Elevations in plasma histamine have previously been reported.3, 5, 6 Furthermore, alterations in tissue mast cells in skin biopsy specimens of patients with EIA have been described. 4, 7 A loss of

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From the Department of Medicine, Case Western Reserve University School of Medicine and the Airway Disease Center, University Hospitals of Cleveland.

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